THIS TIME ON CODE WACK!
How do health insurance hassles, such as denials and preauthorizations, exacerbate inequities in our broken healthcare system? How do they rob physicians of precious time caring for patients and even jeopardize their practices? And why are some big insurance companies buying up physician practices?
To find out, we recently spoke with Dr. Erica Rowe Urquhart, a private practice orthopedic surgeon in northern New Jersey. Harvard-trained in biomedical engineering with an MD and PhD from Johns Hopkins, Dr. Urquhart is the author of the forthcoming book The Invisible Hand Wielding the Scalpel: Paying the Price in America’s Fractured Healthcare System. This is the second episode of a two-part series..
Check out the Transcript and Show Notes for more!
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SHOW NOTES
WE DISCUSS
Last time we talked about problematic insurance practices, such as denials and pre-authorizations. So how do these practices affect the inequities that we have already seen for decades in our healthcare system?
Urquhart: “ [There’s] … government supported healthcare, Medicaid, which is for those that are within a certain financial demographic, and then Medicare, for those … of a certain age demographic. They receive benefits from the federal government.
“Generally those benefits are insufficient to cover the … total cost of care. Medicare may come close, but Medicaid has traditionally far come in far below the actual cost of care.
“And so that creates within our healthcare system, a two-tiered system because Medicaid patients, when they walk in the door, are viewed as a burden to the facility because their reimbursements – what’s going to be paid back to the facility – is not going to meet the cost of care.””
Would you say then that people on Medicaid, who are people of a low-income status, are the ones who suffer the most?
Urquhart: “Yes, they suffer, but not the most.
“I think those that suffer the most, or equally as much, who are more vulnerable, are those who are uninsured because they have no means of paying unless, obviously, they have cash and can pay out of pocket.” …
“… in reality … the burden is on the patient and the provider to make the system work where the insurer is really deciding what they’re going to provide or not provide for patients.”
What systemic reforms, Dr. Urquhart, do you think we need to fix these challenges?
Urquhart: “That’s a huge question. There’s so many moving parts in our healthcare system that it really begs the question of how do we fix something that is this complicated, and has been taken advantage of by so many entities to create profit, right, for shareholders?
How are we going to wrestle our healthcare back from these corporations that are focused on profit and not on the patient?”
I think if I really knew the answer, I’d have the Nobel Prize by now. But what I will say is that what we’re doing right now is very important.
“Having the conversation and pulling back the curtain just to say, you know, this is what’s happening behind the scenes, and trying to educate patients to understand what the dynamic is…
“So I think first is really important, just the educational aspect. Then secondly, I do think that patients,and patient advocacy groups can lobby legislators. Now, many legislators do receive donations from these large healthcare companies and they have a huge lobby, which has been described very thoroughly throughout the literature, but I do still think it’s worth patients making their voices heard and lobbying their legislators either through advocacy groups or just writing letters …
“Now on a personal level, I think that patients also need to hold their insurance companies to task. Those patients that are insured should request their summary of plan benefits.”
Helpful Links
UpMed: The Journal of Healthcare’s Race To The Bottom, A Podcast by Dr. Erica Rowe Urquhart
Vertical Integration Appears Very Profitable For Health Insurers And Is Raising Concern Among Lawmakers And Regulators, The Healthcare Labyrinth Blog
UnitedHealthcare pays Optum doctors more than other doctors: study, Healthcare Dive
Vertical integration is shaping the future of U.S. health care, Brown University School of Public Health.
Episode Transcript
Read the full episode transcript.
Guest Biographies: Erica Rowe Urquhart, MD
Prior to graduation from high school, Dr. Urquhart was distinguished as “America’s Top Student Leader” by the National Association of Secondary School Principals and was recognized as Science Student of the Year at the California State Science Fair. Dr. Urquhart left San Diego for Cambridge, Massachusetts, as a Harvard National Scholar.
While at Harvard, she majored in biomedical engineering while completing her premedical requirements. Upon graduation from Harvard, Dr. Urquhart attended the Johns Hopkins University School of Medicine, where she completed her M.D. and obtained a Ph.D. in molecular and cellular neuroscience in seven years.
Dr. Erica Urquhart was selected for orthopedic surgery residency at the Cornell University-affiliated, all-orthopedic Hospital for Special Surgery. As a resident, she was recognized by the Orthopedic Research and Education Foundation for her developmental biology research performed at Cornell University.
After completing orthopedic surgery residency, Dr. Urquhart joined her husband, Marc in private practice where they formed Urquhart Orthopedic Associates in northern New Jersey.
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